California Health and Human Services Agency

Department of Developmental Services

Plan for the Closure of

SONOMA DEVELOPMENTAL CENTER

October 1, 2015

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TABLE OF CONTENTS

CHAPTER PAGE NUMBER

I. EXECUTIVE SUMMARY…………………………………………………… 1

II. INTRODUCTION AND PLAN DEVELOPMENT PROCESS ………… 5

III. SDC RESIDENTS ………………………………………………………… 16

IV. TRANSITIONS ……………………………………………………………. 20

V. COMMUNITY RESOURCE DEVELOPMENT ……………………….... 29

VI. SDC EMPLOYEES ……………………………………………………….. 37

VII. SDC LAND AND BUILDINGS …………………………………………… 49 .

VIII. IMPACT OF THE SDC CLOSURE …..………………….…................... 57

IX. INPUT RECEIVED ON SDC CLOSURE ……………………………….. 69

X. PROPOSED FUTURE SERVICES AT SDC ……………..…………….. 79

XI. FUTURE USE OF THE SDC LAND AND BUILDINGS ……………….. 81

XII. MAJOR IMPLEMENTATION STEPS AND TIMELINE ……………….. 83

XIII. FISCAL IMPACT OF SDC CLOSURE ……………………………..…… 85

XIV. LIST OF ATTACHMENTS ……………………………………………....... 88

Department of Developmental Services Santi J. Rogers, Director

1600 Ninth Street, Room 240, MS 2-13

TDD (916) 654-2954 (For the Hearing Impaired) (916) 654-1897

Sacramento, CA 95814

http://www.dds.ca.gov/SonomaNews

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http://www.dds.ca.gov/SonomaNews

I.

EXECUTIVE SUMMARY

This “Plan for the Closure of Sonoma Developmental Center” (Plan) was prepared pursuant to Welfare and Institutions Code (W&IC) sections 4474.1 and 4474.11 for submission to the Legislature for approval. It provides important data and information concerning the Sonoma Developmental Center (SDC) residents, the employees, the families and other stakeholders, and the facility land, buildings and leases. It identifies pertinent information on related initiatives and requirements that will have a bearing on services and resource development directly involved in the transformation process. It presents the principles, priorities and commitments of the Department of Developmental Services (the Department or DDS) during the progression toward closure. The Plan formalizes the comments received from stakeholders throughout the Plan preparation process, including those received in meetings and hearings, and through written comments from organizations, associations and individuals. The closure process may involve new policy and/or fiscal issues, and each must be thoroughly vetted, developed and presented publicly for approval, as appropriate and as closure progresses. The Plan captures a point-in-time perspective that will change and evolve with greater dialog and experience so that the best possible outcomes can be achieved for the individuals served, the SDC employees and the Sonoma community.

The closure of SDC will impact all who live or work at the developmental center (DC) as well as their families, friends, and the local community. Together, SDC’s residents, history, highly specialized workforce and unique natural and community assets are significant factors indicating that the closure of SDC will be a very different experience than prior closures. The well-being of the residents and employees of SDC will remain the top priority for the Department throughout the closure process. Acknowledging that change will be difficult, the Department is committed to developing positive options for both the residents and employees, and supporting them in meaningful ways, as well as engaging with the public to determine potential future uses of the SDC campus.

The overriding priority for this Plan is to meet the individual needs of each resident while he or she continues to live at SDC, through every aspect of transition into a community or other living arrangement, as appropriate, and ongoing thereafter. An individualized process is essential for proper planning and assessment of needs, and will include key persons in the resident’s life. Efforts will focus on identifying or developing services and supports to meet the specific needs of each resident, and ensuring the quality of those services through monitoring and oversight functions. Residents will not move from SDC until appropriate services and supports identified in their Individual Program Plan (IPP) are available in the community. The transition planning process will be used to ensure services and supports are appropriately coordinated and in place when the individual moves into his or her new home.

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The input received from stakeholders is the first essential phase of the closure planning process. The Department values the input received so far from SDC families and the dedicated group of community partners that have assembled as the SDC Coalition and their Transform SDC effort. If the Plan is approved, stakeholder input will continue to be critical as the closure process evolves. The Department will work with the SDC Coalition to identify ways that the county and their partners can help realize the transformation of services delivered.

Consistent with statutory requirements, the Plan identifies the essential policies and strategies that will be utilized to:

• Achieve a safe and successful transition of individuals with developmental disabilities from SDC to other appropriate living arrangements, as determined through the individualized planning process;

• Support employees with future employment options by generating or identifying job opportunities, providing assistance, counseling and information, and working closely with the affected bargaining units; and

• Consider the future use of the SDC property.

As the closure process for individuals is driven by the IPP, it is too soon to determine: which communities SDC residents will move to; what resource needs will be identified and developed by Regional Centers (RC) to support SDC residents in the community; what services will need to be provided by SDC during transition; and, what services may be needed and feasible at SDC. The inability to receive federal funding or support for segregated services and institutionalized individuals with intellectual and developmental disabilities, along with the remote location and aging infrastructure of the SDC campus, are significant challenges to establishing homes and services on-site, which the majority of commenters indicated was their preference. As this Plan is further developed, DDS will continue to work with SDC’s families, the larger Sonoma community, and the Department of General Services (DGS) to explore future services that could perhaps be provided at SDC.

Below is a summary of important commitments made in the following Plan:

The Residents of SDC

• Health Resource Center/Clinic Services o The Department will provide key specialized health care/clinic services at

SDC, currently being received by SDC’s residents, on an ongoing basis throughout the transition process, and until necessary services are

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established and operational in the community. These services include, but are not limited to, medical, dental, adaptive engineering, physical therapy, orthotics, mental health, and behavioral services.

• Behavioral Services o In line with the “Task Force on the Future of the Developmental Centers" (DC

Task Force) recommendations and state and federal shifts in how services are provided to people with developmental disabilities, the Department is working with RCs to develop services in the community for individuals with challenging behaviors, including, but not limited to: Enhanced Behavioral Supports Homes (EBSHs), Community Crisis Homes (CCHs), and Delayed Egress/Secured Perimeter homes.

• Crisis Services at SDC o SDC will continue to operate the Northern STAR (Stabilization, Training,

Assistance and Reintegration) home at SDC during the closure process. SDC residents, as well as individuals currently living in the community, will have access to crisis stabilization services as needed and as specified in law. Although Northern STAR is not currently certified by the Centers for Medicare and Medicaid Services (CMS), and is therefore ineligible for federal funding, the Department will pursue independent federal certification as the transition plan for SDC moves forward. DDS will evaluate the ongoing need for the Northern STAR home as part of the closure process.

• Community Oversight o Ongoing oversight and monitoring must occur to ensure that the quality of

care and services continues to meet the needs of persons served after transition, and will be accomplished by implementing a quality assurance plan and a stakeholder advisory group. Data will be made available and accessible to families and decision makers for this purpose.

The Employees of SDC

• Community State Staff Program (CSSP) o The statewide expansion of the CSSP will allow state staff to follow the

individuals they work with at SDC into community settings to provide continuity of care. RCs and the Department are very supportive of this program and are actively encouraging the use of the CSSP for the closure of SDC.

• DDS is committed to further exploring incentives for employees to stay at SDC through the end of closure, and will be discussing potential options with the California Department of Human Resources (CalHR) and appropriate bargaining units.

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The Land of SDC

• Future services at SDC o The Department and DGS are committed to working with the SDC Coalition,

Sonoma County and other interested parties to identify potential options for the future use of the SDC campus.

• Property Disposition o The Administration and the Department recognize the SDC property’s

incredible natural resources, historic importance and value to our service delivery system. It is not the intention of the State to declare SDC’s property as surplus, but instead to work with the community to identify how the property can best be utilized.

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II. INTRODUCTION AND PLAN DEVELOPMENT PROCESS

This Plan was prepared pursuant to W&IC sections 4474.1 and 4474.11 (Attachment 1) for submission to the Legislature for approval. It provides important data and information concerning the SDC residents, the employees, the families and other stakeholders, and the facility land, buildings and leases. It identifies pertinent information on related initiatives and requirements that will have a bearing on services and resource development directly involved in the transformation process. It presents the principles, priorities and commitments of the Department during the progression toward closure. The Plan identifies the essential policies and strategies that will be utilized to:

• Achieve a safe and successful transition of individuals with developmental disabilities from SDC to appropriate living arrangements, as determined through the individualized planning process;

• Support employees with future employment options by generating or identifying job opportunities, providing assistance, counseling and information, and working closely with the affected bargaining units; and

• Consider the future use of the SDC property.

The Plan formalizes the comments received from stakeholders throughout the Plan preparation process, including those received in meetings and hearings, and through written comments from organizations, associations and individuals. The closure process may involve new policy and/or fiscal issues, and each must be thoroughly vetted, developed and presented publicly for approval, as appropriate and as closure progresses. The Plan captures a point-in-time perspective that will change and evolve with greater dialog and experience so that the best possible outcomes can be achieved for the individuals served, the SDC employees and the Sonoma community.

This Plan is the first step in a closure process that has multiple, overlapping phases including stakeholder engagement, the development and approval of a closure plan, resource development, individualized transition planning through the IPP process, and review and modification of the closure plan through the annual budget process. This Plan is a guiding document that is not intended to detail where each individual who lives at SDC will move, what services each individual will need, or the specific transition activities they require. Those decisions will be made by each individual’s Interdisciplinary Team (ID Team), using a person-centered approach and documented through the IPP process.

We appreciate the knowledge and experience of our DC employees, many of whom are second and third generation workers. Their specialized expertise is highly valuable and

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we will look for ways that this expertise can continue to benefit SDC residents. The Department recognizes the importance of building resources for the successful transition of individuals in our DCs, as well as the importance of retaining dedicated, professional staff throughout the closure process and afterwards, to ensure the quality of services.

SDC is scheduled to close by the end of December 2018. There are many challenges associated with this goal, as well as opportunities for review and adjustment of the Plan as we move forward. Important to the ongoing planning process is the identification of resources that currently exist in the community and that still need to be developed, that meet the needs of the persons residing at SDC. The safety of the individuals in transition is paramount and the necessary services and supports will be in place before a resident transitions to a more normalized community setting.

BACKGROUND

Pursuant to existing law (W&IC, Divisions 4.1 and 4.5), DDS is responsible for providing services for persons with developmental disabilities through two primary programs. In the first program, DDS contracts with 21 private non-profit organizations called RCs to develop, manage and coordinate services and resources for persons found to be eligible (consumers) under the Lanterman Developmental Disabilities Services Act (Lanterman Act). Service needs are determined through a person-centered planning approach involving the consumer, the RC, and the parents or other appropriate family members or legal representatives. In the second program, DDS directly operates three DCs and one small community facility providing 24-hour residential care and clinical services. Again, a person-centered planning approach, that includes DC staff, is utilized to identify and meet service and treatment needs of the residents.

Since the passage of the Lanterman Act in 1969, the role of the State-operated DCs has been changing. DCs are no longer the only alternative available to families of children with intellectual and developmental disabilities who are unable to be cared for at home. A system of community alternatives has developed and now serves approximately 290,000 consumers, including many with complex medical and/or behavioral needs that mirror the needs of individuals who live in DCs. Today, providing services in the least restrictive environment appropriate for the person is strongly supported by state and federal laws, and court decisions. Additionally, the trailer bill to the Budget Act of 2012 (Assembly Bill [AB] 1472, Chapter 25, Statutes of 2012) imposed a moratorium on admissions to DCs except for individuals involved in the criminal justice system and consumers in an acute crisis needing short-term stabilization. The DC resident population has dropped from a high of 13,400 in 1968, to a projected total of 1,035 in 2015-16 (May Revision total average in-center population).

Given these changes in the system, efforts have been underway to reconsider how services should be provided to the populations currently served in the DCs, and what role the State should have in providing those services. In 2013, the Secretary of the

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California Health and Human Services Agency established the DC Task Force to develop a master plan for the future of DCs that addresses the service needs of all DC residents and ensures the delivery of cost-effective, integrated, quality services for this population. The DC Task Force consisted of a diverse group of stakeholders including: consumers, consumer advocates, RCs, community service providers, organized labor, families of DC residents, Members of the Legislature, and staff from DDS. Between June and December 2013, DC Task Force meetings were held that were open to the public. The primary focus was to identify viable long‐term service options for the health and safety of DC residents and to ensure that appropriate quality services are available. The DC Task Force gathered facts, shared opinions, analyzed information and developed six thoughtful recommendations for the future of the DCs.

The DC Task Force’s six recommendations were detailed in the "Plan for the Future of Developmental Centers in California," issued January 13, 20141. In the report, the DC Task Force recommended that the future role of the State should be to operate a limited number of smaller, safety-net crisis and residential services. Additionally, it was recommended that the State should continue serving individuals judicially committed to the State for competency training (the Porterville DC [Porterville]-Secure Treatment Program [STP]) and providing transition services (the Canyon Springs Community Facility). The DC Task Force also recommended developing new and additional service components, including development of services for individuals with challenging behaviors, and exploring utilization of DC assets to provide health resource centers and community housing through public/private partnerships. The last recommendation of the DC Task Force was to convene another task force to address how to make the community system stronger.

The need for the system to evolve became more pressing when residential units at SDC were found to be out of compliance with federal standards and the State was notified that the federal funds for those units would cease. The State was able to negotiate a settlement with CMS to continue SDC’s federal funding for a limited amount of time, contingent on adherence to the agreement’s Statement of Tasks2.

The process of moving away from the DCs and developing specialized community resources, while supporting the transition of each DC resident into integrated community settings, will be dynamic and challenging. As the population in the DCs has declined, the average acuity level of individuals remaining at DCs has increased considerably. Each person has his or her own unique set of significant and complex needs, often requiring specialized medical and/or behavioral services. The Lanterman Act requires those needs be addressed using a person-centered approach to support personal quality of life. Key components of effective planning for an individual's future and successful transition from an institutional setting, as recognized by the DC Task Force, include:

1 Available online at http://www.chhs.ca.gov/DCTFDocs/PlanfortheFutureofDevelopmentalCenters.pdf 2 The full text of the settlement agreement and attachments are available on the DDS website at: http://www.dds.ca.gov/SonomaNews/

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http://www.chhs.ca.gov/DCTFDocs/PlanfortheFutureofDevelopmentalCenters.pdfhttp://www.dds.ca.gov/SonomaNews/

• A comprehensive person-centered IPP, developed through a robust ID Team process;

• The development of quality services and supports delivered in the least restrictive environment possible, taking into consideration the comprehensive assessment and consistent with the IPP;

• Priority for the health and safety of each person;

• Access to dental, health and mental health services, including coordination of health care, access to health records, and medication management; and

• Recognition that, for the residents of the DCs, the DC has been their home and community, where their relationships are, and where they have lived for many years. Changes in their living arrangements must be done very carefully, with thorough planning and by investing the necessary time.

While the focus of the DC Task Force was on the future of the DCs and how to best serve the DC residents going forward, its efforts will provide long-term improvements in community services that will benefit the service system generally. Additionally, the Developmental Services Task Force (DS Task Force) was established in July 2014, consistent with “Recommendation Six” in the DC Task Force Plan and in response to Governor Brown’s message in the Budget Act of 2014. The DS Task Force was charged with examining services for individuals with developmental disabilities in the community. The DS Task Force has been working to develop recommendations to strengthen the community system in the context of a growing and aging population, resource constraints, the availability of community resources to meet the specialized needs of consumers, and past reductions to the community system. To date, workgroups of the DS Task Force have focused on issues around community rates and RC operations.

The Budget Act of 2015 includes $49.3 million ($46.9 million General Fund) to begin development of community resources to support the transition of SDC residents. These resources will fund the initial development of homes to support consumers, provide additional training for providers, and develop additional programs such as supported living services, day or employment services, crisis services, and transportation support and services. This funding will also be used for State coordination of the closure. Initial investment, development and coordination activities are tied to the existing Community Placement Plan (CPP) processes and are not intended to minimize family input since they include development of services and supports already identified through the existing IPP process. In order to keep within the closure timeline, some activities must start immediately using the resources provided for 2015-16. Additional family input through the IPP process will further define future resource development.

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New federal rules affecting where home and community-based services (HCBS) are delivered became effective last year, and will require homes and programs to meet new criteria in order to qualify for federal funding under the federal Medicaid program (called “Medi-Cal” in California). This will influence the development of community-based services for individuals living at SDC, as well as the potential for the future use of the property at SDC for housing and services. HCBS are long-term services and supports provided in home and community-based settings, as recognized under Medi-Cal. These services can include, but are not limited to: case management (i.e., supports and service coordination), homemaker, home health aide, personal care, adult day health, habilitation (both day and residential), and respite care services. States can also propose "other" types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community. In general, settings and services that have the qualities of an institution will not be supported.

The California Department of Health Care Services (DHCS) has developed a Statewide Transition Plan (STP) submitted to CMS on August 14, 2015. The STP describes how the State will come into compliance with the new federal home and community-based settings requirements. States have until March 17, 2019, to implement the requirements for home and community-based settings in accordance with CMS-approved plans.

The final rule supports enhancement of the quality of HCBS, adds protections for individuals receiving services, and provides additional flexibility to states that participate in the various Medicaid programs authorized under section 1915 of the Social Security Act. Highlights of the final rule include:

• Defines person-centered planning requirements;

• Defines and describes the requirements for home and community-based settings appropriate for the provision of HCBS:

o Nursing facilities, institutions for mental diseases, intermediate care facilities for individuals with intellectual disabilities, hospitals, other locations that have qualities of an institutional setting, as determined by the Secretary of the federal Department of Health and Human Services, are not defined as home and community-based settings for Medicaid reimbursement purposes;

• Identifies the types of settings that CMS presumes to have the qualities of an institution as:

o Any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment;

o Any setting that is located in a building on the grounds of, or immediately adjacent to, a public institution; or

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o Any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS.

We are strongly committed to ensuring the provision of quality care for individuals while they reside at SDC and as they transition to community-based services. The closure of SDC is a next step in the State’s process of transforming how services are delivered to individuals with significant service needs. As the State moves toward closure for SDC and potentially other DCs, stakeholder engagement will continue to be used to inform processes, monitor changes and make recommendations for the most effective use of available resources.

PLAN DEVELOPMENT PROCESS

On May 14, 2015, the SDC closure was proposed as part of the May Revision. The announcement began a multi-faceted process to develop this Plan pursuant to W&IC section 4474.11, which was passed as part of a trailer bill to the Budget Act of 2015 (Senate Bill [SB] 82, Chapter 23, Statutes of 2015). The new law requires that a closure plan for at least one of the DCs be submitted to the Legislature by October 1, 2015, so that legislatively-approved closure activities can begin in the current fiscal year. Additionally, the Department may develop community resources and utilize funds allocated for that purpose as part of the Budget Act enacted through the 2015-16 Regular Session of the Legislature. Implementation of this closure plan following 201516 is contingent upon legislative approval as part of the legislative budget process during the 2016-17 Regular Session. A plan submitted pursuant to W&I Code section 4474.11 may be modified during the legislative review process.

Consistent with the May Revision, the Department moved forward with developing this Plan for the closure of SDC. The Department made it a priority to meet in-person with as many stakeholders as possible, hear their concerns, perspectives and issues, and inform the Plan. Recognizing the time limitations of the planning process, meetings were held with residents, families, employees, unions, advocates, RCs, providers, local government officials, State legislative representatives, and other organizations from May through September 2015. In addition, the Department corresponded with staff, families, Members of the Legislature, federal and local government representatives, and the broader developmental services stakeholder community. Letters that were sent to notify interested parties of the closure announcement are provided in Attachment 2.

On July 18, 2015, the first of two formal public hearings was held in Sonoma at the local high school. The hearing was well attended with 87 stakeholders providing testimony. In addition, DDS received written input from 315 stakeholders. The second public hearing was held on September 21, 2015, at the Renaissance Lodge at Sonoma. It provided the opportunity for the Department to receive comments on the draft plan so modifications could be made before this final Plan was formally transmitted to the

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Legislature. Forty-seven individuals commented at the second hearing and an additional 40 written comments were received by the Department through September 23, 2015.

The input received from the hearings and various meetings is summarized in Chapter IX, and the written correspondence is contained in Attachments 3-A and 3-B (separately bound compilations of stakeholder comments).

The Department has coordinated with impacted State departments and the Association of Regional Center Agencies. The Department scheduled a meeting for bargaining unit employee representatives to provide information and receive feedback. The closure of SDC was an agenda item discussed at the Olmstead Advisory Committee and State Council on Developmental Disabilities (SCDD) meetings. The Department also consulted with Disability Rights California (DRC) and reached out to provider groups, consumer groups, community representatives and local government.

Unique to SDC, the Department has worked with a diverse group of community partners through the SDC Coalition and their Transform SDC effort, since first being invited to join in March 2014. DDS’ ongoing participation allowed DDS to better understand the desires and needs of the local community, even before closure was announced, and to act as a resource to this vital community organizing effort.

A detailed list of all stakeholders contacted during the Plan preparation process is provided as Attachment 4. Additionally, Attachment 5 provides the calendar of the activities and meetings that took place.

The closure of SDC will significantly impact many lives, especially the residents who benefit from the care and services provided at SDC. The general sentiment communicated to the Department during public hearings and in written comments, predominantly by families, employees and community partners, is that SDC should not close entirely, but instead services should be rebuilt and reimagined on SDC’s property to continue to provide services that will benefit the residents of SDC, all people with developmental disabilities and the general Sonoma community. Advocates and RCs support closure and emphasize the need for individualized program planning, expansion of community resources, appropriate funding and the inclusion of individuals in everyday community-based settings.

The input received from stakeholders is the first essential phase of the planning process. If the Plan is approved, stakeholder input will continue to be critical as the closure process evolves. Efforts and activities require meaningful communication and coordination as progress is made, and the Department will rely heavily on continuing stakeholder involvement. As identified later in this Plan, DDS intends to establish three advisory groups for future input and guidance toward a smooth and successful closure. Additionally, the Department values the input of the dedicated group of community partners that have assembled as the SDC Coalition and their Transform SDC effort, and

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will continue to work with the SDC Coalition to identify ways that Sonoma County and their partners can help realize the transformation of services currently delivered at SDC.

The RCs are committed to working with consumers and families throughout the process of identifying and developing community resources. Local RCs have already been meeting with families and the Parent Hospital Association (PHA), and several have representatives that are actively involved with the SDC Coalition. The RCs appreciate the input received so far and are already responding to specific requests, such as:

• Helping families learn more about supported living services (SLS);

• Working with Sonoma County and SDC management to gain a better understanding of where families want their loved ones to live in the future;

• Identifying ways to help families see and learn about different residential and service models; and

• Developing training for SDC employees who want to learn more about opening a community home or service.

PLAN APPROACH

The Plan builds on several innovative strategies which contributed to previous DC closures, as well as embracing new models of care recommended by the DC Task Force to meet the complex needs of the individuals who live at SDC when they move into the community. The licensure category for facilities to serve individuals with enduring medical needs has been expanded statewide, as has the CSSP to allow state staff to follow individuals they work with at the DCs into community settings. Specific to the closure of SDC, the Department is also working with RCs to develop EBSHs, CCHs and Delayed Egress/Secured Perimeter homes. Efforts are underway to ensure DC families are aware of self-determination as a potential option for individuals and their families to have more freedom, control, and responsibility in choosing services and supports to help them meet objectives in their IPP. Overall, these community service options will provide meaningful choices and reliable services to consumers transitioning from SDC.

The overriding priority for this Plan is to meet the individual needs of each resident while he or she continues to live at SDC, through every aspect of transition into another living arrangement, and ongoing thereafter. An individualized process is essential for proper planning and the assessment of needs, and will include key persons in the resident’s life. Efforts will focus on identifying or developing services and supports to meet the specific needs of each resident, and ensuring the quality of those services through monitoring and oversight functions. Residents will not move from SDC until appropriate services and supports identified in their IPP are available in the community. Services may include, but are not limited to, residential, day, vocational, health care, behavioral

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health and dental services. The transition planning process will be utilized to coordinate the timely delivery of services so that they coincide with the individual’s move.

The Department is also committed to assisting SDC employees during the closure process. They will be supported in a number of important ways aimed at generating and identifying future job opportunities. As a priority, the Department will concentrate on methods to retain employees within the developmental disabilities services system. In 2014, W&IC section 4474.2 was amended to allow employees to be able to work in the community with residents who are transitioning from any DC, including SDC. The statewide expansion of the CSSP allows any DC resident, even those not under a closure plan, to benefit from the continuity of care and the experience of DC employees. The Department will also communicate job information and assist employees with job-search preparation and endeavors. Throughout the closure process, the Department will work closely with the affected bargaining units and tailor assistance efforts to address employee circumstances and the Sonoma area’s job market.

The major implementation steps and timeline for this Plan are presented in Chapter XII.

PARAMETERS AND PRINCIPLES THAT WILL GUIDE IMPLEMENTATION

There are important parameters and principles that will affect future planning and implementation efforts as the closure of SDC progresses. The parameters and principles that must be considered and appropriately addressed include:

• Meeting the needs of the SDC residents, now, during transition and ongoing through quality services, and ensuring their health and safety;

• Enabling the active and meaningful participation of the consumers, families, consumer representatives, advocates, RCs, the Sonoma community and other interested parties throughout the closure process;

• Being in compliance with federal and State laws, and applicable court decisions;

• Being in compliance with the settlement agreement entered into by various State entities and CMS that requires the California Parties to address compliance issues at SDC and achieve appropriate community or other placements for residents of the affected SDC units, so that federal funding will continue, as specified in the agreement;

• Implementing and being in compliance with the new federal regulations for HCBS.

• Effectively using State funds and maximizing federal funds for the short- and long-term costs associated with the delivery of services and the closure of SDC; and

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• Implementing this Plan as approved by the Legislature through the legislative budget process, including any future modifications.

LESSONS LEARNED

The Department recognizes the need to learn from past experience and has the benefit of being able to examine “lessons learned” from the relatively recent Agnews (2009) and Lanterman (2014) DC (Agnews and Lanterman, respectively) closures for applicability to the closure of SDC. Recognizing that each DC closure is a very different experience informed by different resident populations, different surrounding communities and stakeholders, and different employment and service options, some common themes presented themselves.

An informal assessment compiled from a variety of parties involved with the Agnews closure process identified that the use of the CSSP was essential to building support for and the effective carrying out of transitions for Agnews residents. Pay inequities between state-employed staff in the community and other community staff having the same responsibilities, was an issue. Carefully negotiated rates or reimbursements were suggested as possible ways to enhance the CSSP in future closures. It was also noted that overnight visits proved to be very helpful for residents with behavioral challenges in order to feel comfortable with the move; the use of Non-Profit Organizations (NPO) in acquisition and development of homes worked well; families and residents had the opportunity to visit the housing models which helped with the decision-making of residential options and ease concerns about transition; early planning and a strategy for working with health plans and a payment system are as important as developing housing arrangements; the importance of starting day programs immediately upon the individual arriving at the behavioral/medical home, and thereby establishing a living pattern right away; and it would be helpful to have an Occupational Therapist (OT) involved during the planning stages of remodel or construction projects, as knowledge of the residents’ needs would be beneficial during the design phase. Families were not interviewed as a part of this assessment; however, information shared by families since the closure indicates that many families are very pleased with their loved ones’ transitions.

Many Lanterman families also expressed that they are very pleased with their loved ones’ new homes and described their loved ones as “very happy.” Families conveyed that their loved ones’ physical, medical, emotional, spiritual and social needs are taken care of in the community and they have built strong, trusting relationships with staff in the homes. Staff in the homes is described as “caring,” “competent,” “consistent,” “compassionate,” “tops,” and “quality.” Families like the physical attributes of the homes (clean and truly homelike, good adaptations for people with disabilities, necessary specialized medical equipment is right in the home) and appreciated that homes were built in “nice areas” or near their homes, enabling more frequent visits. Many families shared instances of personal growth experienced by their loved ones since moving to

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the community (speaking for the first time, enhancing their vocabulary, learning new skills, participating in new activities, reduction of behaviors or outbursts, etc.). Also shared was that access to medical care has not been a significant barrier, and in instances where there were delays, the RCs were able to effectively address the issue.

More recently, a letter was received from the Parent Coordinating Council & Friends for Lanterman urging the Department to suspend placements out of SDC (implement a “moratorium”) until there is conclusive evidence that “equal or better” services and supports are available in the community.

Other issues raised by Lanterman families that the Department has taken note of are: there may be a need for National Core Indicator (NCI) process improvements to ensure movers and their families are able to participate; funds should be made available now to address community issues experienced by Lanterman movers, and for future movers; high staff turnover and low pay continue to be issues in community-based homes; concerns exist about the availability of dental care, especially sedation/general anesthesia dentistry; cross-training of community staff should start sooner in closure, so the DC staff who know residents the best are the ones training their counterparts in the community, not just the staff left at the end of closure; day program services need to be developed specifically for DC movers, as they present unique challenges standard day programs may not be able to address; and families overwhelmingly felt there should be consistent coordination and approval of services among all 21 RCs so that the same types of services can be available anywhere they are needed and easily accessed by families. Different usage of some service types and varying vendorization and approval processes by RCs have troubled some families and consumers that moved from Lanterman.

Together, SDC’s residents, history, highly specialized workforce and unique natural and community assets are significant factors indicating that the closure of SDC promises to be a very different experience than prior closures. The Department recognizes the unique challenges and opportunities presented by the closure of SDC and will continue to work closely with stakeholders for the best possible outcomes.

Focusing foremost on ensuring the lifelong health and safety of SDC’s residents, followed by protecting the interests of SDC’s employees and responsible utilization and stewardship of SDC’s land, this Plan for the Closure of Sonoma Developmental Center is presented for consideration and approval by the Legislature.

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III. SDC RESIDENTS

The highest priority of the Department in developing this Plan is to ensure the continued health and safety of the SDC residents during and following their successful transition to appropriate living arrangements identified through the individual planning process. The Plan is informed by significant data and information about the men and women who reside at SDC (Attachment 6) and important input received from meetings with residents, family members, employees and local interests; the public hearings; and extensive correspondence received via email, by mail or through the online submission form made available on the DDS website (Attachments 3-A and 3-B).

The following sections specifically identify the overall demographics of the population residing at SDC. Following chapters describe the expected transition planning process to be used for each individual during closure and the recommended development of services based upon assessed need, stakeholder input and knowledge of the current community system in Northern California.

DEMOGRAPHICS

Level-of-Care and Services Provided at SDC: SDC currently provides services to residents under three levels-of-care. The facility is licensed as a General Acute Care Hospital with distinct licenses for an Intermediate Care Facility (ICF) and Nursing Facility (NF). As of May 1, 2015, 405 people were in continuing residence at the facility with 181 individuals (approximately 45%) living on one of ten NF residences and the remaining 224 (approximately 55%) residing on one of the facility’s 11 ICF residences. The census on each of the NF or ICF units ranges from 1 to 25 residents. An additional ICF residence provides services where area individuals in crisis are admitted to receive short-term stabilization and return to a community setting. The third level-of-care is provided on the Acute Care unit where residents are transferred to receive short-term medical and nursing care when they experience an acute health care condition.

RC Communities: SDC is primarily a resource to the Northern California area with about 98% of the individuals who reside at the center being served by a northern area RC. Four RCs are responsible for the majority of individuals living at SDC, with the other RCs having ten or fewer in residence: 128 residents (32% of SDC’s population) are served by RC of the East Bay, 103 (25%) are served by Golden Gate RC, 86 (21%) are served by North Bay RC, and 55 (14%) by Alta California RC. The remaining 8% of residents are served by other RCs: 10 by Far Northern RC, 10 by San Andreas RC, 6 by Redwood Coast RC, and 3 by Valley Mountain RC, with San Diego RC, Tri-Counties RC, South Central Los Angeles RC, and North Los Angeles RC serving one resident each. The population by RC is summarized in Attachment 7.

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Length of Residence: The majority of residents have lived at SDC for many years, with 62% having resided there for more than 30 years. The breakdown on the length of stay for the remaining residents shows 23% have made SDC their home for 21 to 30 years, another 8% for 11 to 20 years, 4% for 6 to10 years, and 3% for 5 or fewer years.

Age: SDC’s population is older, with more than 90% of the residents over age 40. People aged 65 years or older make up 23% of the population, with the oldest being 91 years of age. There are no children less than 18 years of age.

Family Involvement: About 75% of the resident population at SDC as of May 1, 2015, has identified family connections and involvement: 156 (38%) are conserved by family, and 148 (37%) have family representatives. An additional 47 (12%) are conserved, 36 (9%) access advocacy services, and 18 (4%) have no identified representative. All individuals are identified as needing assistance in making life and care decisions.

Gender and Ethnicity: The resident population at SDC is 59% male and 41% female. Eighty-six percent (86%) of the population is identified as White, with 6% identified as Black/African American, 3% identified as Hispanic/Latino, and the remaining 5% identified as Asian, Pacific Islander, Filipino or Other.

Developmental Disability: Section 4512(a) of the Lanterman Act defines developmental disability as a:

“… [d]isability that originates before an individual attains 18 years of age; continues, or can be expected to continue, indefinitely; and constitutes a substantial disability for that individual…[T]his term shall include intellectual disability, cerebral palsy, epilepsy, and autism. This term shall also include disabling conditions found to be closely related to intellectual disability or to require treatment similar to that required for individuals with an intellectual disability, but shall not include other handicapping conditions that are solely physical in nature.”

Seventy-one percent (71%) of the consumers who reside at SDC have profound intellectual disability and 21% have severe intellectual disability. The remaining 8% are persons who have been assessed with moderate, mild, or other levels of intellectual disability. Some residents also have mental health issues, with 29% identified as having a significant impact. A majority of residents have additional disabilities including 55% of the population with epilepsy, 23% have autism, and 51% have cerebral palsy. In addition, 64% of the residents have challenges with ambulation, 81% have vision difficulties, and 26% have a hearing impairment.

Primary Service Needs

Residents at SDC require a variety of services and supports. The following defines five broad areas of service and identifies the number of consumers for whom that service is their primary need:

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Significant Health Care Services: This need includes the need for intermittent pressure breathing, inhalation assistive devices, tracheotomy care, or treatment for recurrent pneumonias or apnea. Significant nursing intervention and monitoring are required to effectively treat these individuals. One hundred nine (109) of SDC’s residents (27%) have significant health care needs as their primary service need.

Extensive Personal Care: This need refers to people who do not ambulate, require total assistance and care, and/or receive enteral (tube) feeding. Ninety-one (91) residents of SDC (22%) require extensive personal care as their primary service need.

Significant Behavioral Support: This need addresses individuals who have challenging behaviors that may require intervention for the safety of themselves or others. Eighty (80) residents (20%) have been identified as requiring significant behavioral support as their primary service need.

Protection and Safety: This need refers to those individuals who require a highly structured setting because of a lack of safety awareness, a pattern of self-abuse or other behavior requiring constant supervision and ongoing intervention to prevent self-injury. One hundred twenty-five (125) of the residents (31%) require highly structured services as their primary service need.

Low Structured Setting: This service need addresses those consumers who do not require significant behavioral support or intervention but do require careful supervision. No one residing at SDC (0%) was identified in this category.

PLANNING FOR RESIDENT RELOCATION PERSON BY PERSON

Stakeholder input has been significant regarding the closure plan and, more specifically, as it relates to the men and women who live at SDC. The vast majority of input has come from families of SDC residents and members of the SDC Coalition and their Transform SDC effort. Overall, input received has noted significant concerns and/or opposition to the closure. However, many have indicated that, as it appears that the closure is going to proceed, a number of issues must be addressed to ensure the continuity of specialized services and development of new models of service on the grounds of SDC. Based upon the lessons learned from previous closures, the recommendations shared by those providing input to the Department on this proposal, and the Department’s obligations under the CMS settlement agreement, the following stakeholder priorities have informed this Plan:

• Decisions will be based on individualized transition planning, which includes family members, to ensure safe transitions for each individual living at SDC. Closure will not occur until appropriate services, as identified in each individual plan, are available in the community and all residents have moved.

• Community resources, including residential and day services, must be developed.

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• The specialized medical and dental services currently available at SDC will remain available via a health resource center until equivalent services are identified, or where lacking, are developed within local communities.

• Behavioral and crisis support services will continue to be available at SDC during the closure process.

• Ongoing oversight and monitoring must occur to ensure that the quality of care and services continues to meet the needs of persons served after transition. Data will be made available and accessible to families and decision makers for this purpose.

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IV. TRANSITIONS

INDIVIDUALIZED PLANNING PROCESS

The closure process will be designed to ensure a safe transition for each resident. In developing each person’s IPP, as mandated in the Lanterman Act, the ID Team will meet to identify each person’s goals and objectives, and the services and supports that will be provided based upon the resident’s assessed needs, preferences and choices. The meeting includes the resident; the legally authorized representative, family and/or advocate; identified staff from the DC and the Regional Resource Development Project; one or more RC representatives, including the RC service coordinator; and others invited by the resident or his or her authorized representative. DC team members include staff that provides direct services to the resident, including physicians, nursing staff, psychology staff and ancillary staff, as indicated based on their involvement with the individual.

Every person has already had a comprehensive assessment completed by their RC that identifies the person’s choices, preferences and the types of community-based services and supports needed to ensure a successful transition to a community setting. This comprehensive assessment will inform the process and be updated on an annual basis until the person has transitioned to the community.

SDC is assisting the men and women who live at SDC prepare for their maximum participation in the ID Team process by having discussions with them on the closure proposal, providing education regarding their choices, and increasing their opportunities to explore and visit the community options. A town hall meeting was also held with the persons at SDC to discuss the closure, items that are important to them during the closure, as well as the supports and services they will need.

The IPP and related transition activities are all part of a coordinated and fluid planning and implementation process that is flexible and ongoing to meet each consumer's unique needs during and after transition. ID Team members exchange information; perform and participate in assessments; document findings, recommendations and outcomes; and carefully coordinate the transition from the DC to the community. Beginning August 31, 2015, the person-centered IPP process is now more focused on transition planning for each SDC resident. The SDC staff and local RCs are working together to ensure the men and women who live at SDC and their families become actively engaged in evaluating community options.

Through the ID Team process, SDC and RCs will work with individuals, families and, where appropriate, other participants, to review transition options based on each individual’s assessed needs, preferences and choices, including such options as SLS and the Self-Determination Program. SDC will increase the opportunities for more

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individuals to participate in community tours and experience living options. SDC will coordinate “meet and greet” introductions to potential providers so that the person, their family and providers can see if a specific option identified through exploration activities has the potential for success.

Once a person has had a successful “meet and greet” and it is determined a specific living option should be pursued, the transition planning process will include visits to the prospective home, planned meetings between the proposed vendor and the person, spending time in the home, meeting other individuals who already reside in the home and meeting the staff. The transition planning process is flexible and will be tailored to each person’s interests and needs, as determined by the ID Team.

As part of the transition planning process, the ID Team will begin preparing an Individualized Health Transition Plan (IHTP), as well as Specialized Behavior and Safety Plans for the person, when applicable.

• Individualized Health Transition Plan

A comprehensive IHTP will be developed by the ID Team and incorporated into the IPP for each resident transitioning from SDC. The IHTP will include the person’s health history and current health status provided by the person’s medical staff. The person, involved family members, conservator, authorized representative and/or advocate may participate in the development of the IHTP. The IHTP will provide specific information on how the individual’s health needs will be met and the health transition services that will be provided, such as occupational therapy, respiratory therapy and other specialized health procedures. The IHTP will assist the ID Team in assuring all of the necessary health supports are in place prior to the move from SDC.

• Specialized Behavior and Safety Plans

Where indicated by the IPP, the ID Team will develop a comprehensive Specialized Behavior Plan that will be incorporated into the IPP. Also as indicated, it will develop and incorporate a Safety Plan that includes components related to safety for consumers who have significant behavioral support needs, who currently have rights restrictions, or who may need the use of highly restrictive methods such as psychoactive medications. The Specialized Behavior Plan and the Safety Plan will assist new service providers in understanding the needs of the individual and adequately providing the needed behavioral supports in new settings.

Familiarization (Cross-Training) Activities

The IPP will include specific activities for familiarization of new staff with the details of the comprehensive assessment and the IPP, including the Specialized Behavior Plan,

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along with any informal or personalized knowledge from the SDC staff who know the individual best. Activities may include meetings with the ID Team and providers (including residential, day services, vocational, health care, behavioral health and any other provider identified in the transition plan) to exchange information specific to that individual’s transition plan.

Cross-training of community providers by SDC staff is accomplished through in-person visits of SDC staff or the provider (at the provider’s location or at SDC), simulated training situations, or actual observation of daily activities and programming across support settings. Through the stakeholder input process, SDC employees identified that extensive, repeated cross-training is necessary to build relationships and rapport between new staff and consumers as well as to address complex needs and procedures.

Transition Review Meeting

Once the initial transition plan has been implemented and when all members of the ID Team are satisfied that the arrangements agreed upon in the planning process have been implemented, will meet the person’s needs, and the person is prepared to move, the ID Team holds a Transition Review Meeting (TRM). At the TRM the ID Team reviews and finalizes the consumer’s IPP, including the transition plans, the IHTP, the Specialized Behavior Plan and the Safety Plan, as applicable. The TRM is held at the conclusion of the transition process and is where the ID Team sets a placement date. TRMs must occur no less than 15 days prior to the planned move.

Monitoring Resident Transition

During stakeholder input for preparation of this Plan, many individuals communicated a concern over the process that will be used for the monitoring of transitions from SDC. While there is a transition planning process currently in place today at SDC, there have been various practices utilized during previous closures that helped to achieve successful transitions. As a result of this prior experience, the Department has determined the need for a Resident Transition Advisory Group (RTAG) to be established for SDC as well. The RTAG will include membership from the SDC Resident Council and representation from parents and family members, the involved RCs, and DDS. This advisory group will evaluate the current transition planning process in place for residents at SDC and make recommendations to the Department for enhancements. Previous transition practices that have worked well will be shared with the RTAG to assist in the evaluation.

Additionally, the Department is in the process of contracting with an independent external organization with proven capabilities in quality assurance systems in the ICF/Individuals with Intellectual Disabilities (IID) environment to serve as an independent monitor. This independent monitor is required by the CMS agreement and will be responsible for the development of a monitoring plan and implementation of

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quality assurance performance indicators. Additional specialized monitoring of the transition process and outcomes will be developed by the independent monitor based on information gained during the transition process. The independent monitor will also conduct frequent monitoring of conditions and staffing levels at SDC with the emphasis on provisions of Active Treatment, Quality Health Care outcomes, Behavioral Health outcomes and Client Protections.

The Department will also develop and implement a detailed quality management plan for SDC that will be maintained during the closure process. It will include a quality oversight and internal monitoring system with tools and data, and a stakeholder advisory group, as described in the Quality Management System (QMS) section, below. The QMS will be applied by both internal and external reviewers.

In line with employee and family input, the Department recognizes the importance of ensuring that residents continue to be well served by staff familiar with each person’s needs throughout the closure process. It is also essential that each resident’s ID Team involve the participation of knowledgeable staff. As was learned during previous closures, due to the early departure of knowledgeable employees, significant effort was required on the part of the Department to stabilize the care and services during the final months of closure. The Department is committed to providing diligent monitoring and management of staffing levels to ensure the needs of the residents are met.

Follow-up to Ensure Service Adequacy

The Department currently operates three Regional Resource Development Projects, including one at SDC (the Sonoma Regional Project [SRP]). Consistent with the previous closures, SRP staff will remain involved with persons moving from SDC into the community and will provide a core quality assurance function. After a person has moved to his or her new community-based home, SRP, in coordination with the RC, completes a number of face-to-face visits with the individual. These visits have been enhanced for additional monitoring to occur during the transitioning process. Scheduled visits occur following an individual’s move from SDC at intervals of 5 days, 30 days, 90 days, 6 months, and 12 months. Additional visits, or assistance with follow-up activities or guidance, occur as necessary to assure a smooth transition.

In addition, the RC is directly involved in the actual transition of the individual to his or her new home. Anyone moving from SDC to the community will receive enhanced RC case management for at least two years. For example, for anyone residing in out-ofhome placement, the RC will complete a face-to-face visit at least quarterly. Individuals who move to an ARFPSHN or an EBSH will receive enhanced clinical staffing in the home and oversight by the RC and the Department that is statutorily required for those models of care. Additional visits, supports, and training are provided to the individual and/or the service provider on an as-needed basis.

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A summary of established monitoring activities is provided in Attachment 8, Transition and Oversight of Residents Moving from Lanterman Developmental Center to the Community.

Contingencies for Meeting Consumer Needs

Once placement has occurred, the Department is committed to support consumers so that they can successfully continue their community placement. As part of the transition planning process, the ID Team will identify any known or anticipated issues or challenges the consumer could experience in their new setting, and where indicated, develop a contingency plan of provisions that might be needed to support the individual in the community.

Throughout the placement process, several monitoring and follow up activities are conducted by the RC and the SRP, as described above. This ongoing effort allows for identification of any issues that may be arising with the placement and help ensure timely intervention. As needed, the RC or SDC will provide for additional resources to support the individual in their new home. SDC staff may render necessary services in order to complement the community resource. If post-placement monitoring and support efforts are not successful, an additional assessment process under W&IC section 4418 may be initiated, and SRP may arrange for other services as resources permit in order to assist a consumer’s adjustment in the community or in an effort to prevent return/readmission.

While SDC is open, and when an individual’s legal status permits, prior residents of SDC may be placed on provisional placement for a period of up to one year. The length of the provisional placement may be less in those cases where the court’s authorization of placement at SDC expires before that date or when the facility closes. Such a placement affords a right of return to SDC at any time during the provisional placement period when an adequate standard of care cannot be maintained in the particular placement. Upon the request of the RC, the provisional placement return process may be utilized when a consumer experiences challenges that cannot be resolved in the community setting.

QUALITY MANAGEMENT SYSTEM

Use of a thorough and transparent QMS to ensure safe and successful transitions from SDC and ongoing quality care is not only required of the Department, but was also widely stated as a need by many stakeholders. Over the past 15 years, California has moved steadily toward a more integrated, value-based quality management and improvement system that produces desired consumer outcomes. The statewide QMS is based upon the CMS Quality Framework. At the core of the model is the consumer and family. Quality management starts with establishing clear expectations for performance (design), collecting and analyzing data to determine if the expectations are met (discovery), and finally, taking steps to correct deficiencies or improve processes and services (remediation and quality improvement).

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RCs have a strong foundation in quality management activities based upon requirements in statute and regulation. For example, RCs have active quality assurance departments whose staffs work to recruit, train, and monitor providers to continuously improve service quality. Case managers meet with consumers in out-ofhome living options at least quarterly; in licensed homes two of these visits are unannounced. Each RC regularly reviews Special Incident Report information and implements actions to decrease risks to health and safety while honoring consumer choice, community integration and independence. Regular in-service trainings are provided to RC staff. RCs train their staff and providers in specialty areas, such as positive behavioral supports. They develop, implement, and monitor Corrective Action Plans for service providers, when needed. Each RC has a 24-hour response system wherein a duty officer can be reached after hours.

In addition to the current statewide QMS and RC quality management processes, an active SDC QMS in development and will be maintained by the Department (in conjunction with the RCs) to monitor consumers’ quality outcomes and satisfaction and identify areas that may need improvement. The QMS strategy for the SDC closure will be enhanced by building upon the existing DDS and RC quality assurance systems and incorporate the Department’s obligations under the CMS agreement. The focus of this strategy will be on assuring that quality services and supports are available prior to, during, and after transition of each person leaving SDC. Specifically, the SDC QMS will include the development, implementation, and monitoring of service provider performance expectations, individual outcomes, and systemic outcomes and process measures including:

• The development and monitoring of the IHTP for every SDC resident;

• Enhanced monitoring by RC clinicians (when identified in the IPP);

• An additional year of RC case management at a 1:45 caseload ratio;

• Establishment of a Quality Management Advisory Group (QMAG) specific to SDC;

• An annual family and consumer satisfaction survey through the NCI project for all individuals transitioning from SDC and their families.

o The NCI survey addresses key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety. There is a face-to-face/in-person interview for individuals receiving services and a mail-in survey for families or conservators. NCI surveys are anonymous;

• On-site visits and interviews o Once fully implemented, the SDC QMS will enable RC staff, clinicians,

and other professionals, SRP staff, and other involved parties that visit the

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home to assess individuals and service providers based on the established service provider expectations and individual outcomes;

• Review of IPPs o RC staff will review IPPs for content and quality to ensure that person-

centered planning objectives, health and safety issues and the services and supports identified through the transition process are being met;

• Semi-Annual Risk Management Reporting by the DDS risk management contractor that will include:

o Reportable Incidents – The number and rate of reportable incidents among people moving from SDC will be captured and reported using Special Incident Reports. As required by Title 17, Section 54327 of the California Code of Regulations, vendors and long-term health care facilities report occurrences of suspected abuse, suspected neglect, injury requiring medical attention, unplanned hospitalization and missing persons, if they occur while a consumer is receiving services funded by a RC. In addition, any occurrence of consumer mortality or a consumer being a victim of a crime must be reported, whether or not it occurred while the consumer was receiving services funded by a RC;

o Changes in residential settings – Data on residential settings from the Client Master File (CMF) and Purchase of Services (POS) data will be used to identify changes in residence type. Instability in residence may indicate potential care issues or may indicate changes in service needs; and

o Changes in skills of daily living, challenging behaviors and personal outcomes – Elements tracked through the Client Development Evaluation Report (CDER) will be monitored for potential deterioration or improvement of the consumer over time. The CDER is completed at the time of transition and at least annually once a person has moved to the community.

Essential to the SDC QMS is the establishment of a QMAG. Representation on the SDC QMAG will include consumers, parents and family members of current and former SDC residents, RCs, the SCDD, and DRC. The Department anticipates establishing the SDC QMAG by November 2015.

The QMAG will provide guidance to the Department and RCs in the refinement of the SDC QMS. On an ongoing basis, the QMAG will inform the Department and RCs on findings from their review of the data collected on the quality of services being provided to former SDC residents. The independent monitor will also inform the SDC QMS. The

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QMAG is a potential avenue for SDC families to interact with, and hear from, the independent monitor. During the stakeholder process for this Plan, family members specifically requested the sharing of information by, and with, the independent monitor throughout the closure process.

Once formed, the QMAG will have the opportunity to review and give input on the outcome and process measures required for SDC’s closure. Stakeholders have suggested timelines for placement reviews, additional measures of success and refined processes. Stakeholders also provided the Department with another state’s legislation that details reporting requirements and process measures for follow-up studies of individuals who have moved out of that state’s developmental centers and psychiatric hospitals. Subject to available funding, the Department will work with the QMAG and other stakeholders to review all proposals for appropriateness, viability and potential incorporation as enhancements to the SDC QMS are decided.

ADVOCACY SERVICES

The Department will work on maintaining the Volunteer Advocacy Services (VAS) program until final closure and then transitioning the services to the community. The VAS program, funded by the Department and implemented via an interagency agreement with the SCDD, is designed to provide advocacy resources and assistance to persons living in state-operated facilities, who have no legally appointed representative to assist them in making choices and decisions. In addition, at the request of legally appointed representatives, volunteer advocates will assist those representatives in advocacy efforts. The residents access these services through their own requests as well as through referral by the DC based upon their need for assistance and/or representation and the lack of other available resources. Services range from facilitation of resident involvement in social and recreational activities, to attendance with the resident at program planning and other meetings impacting services and supports for the resident. When a resident receiving services from VAS moves from SDC to the community, VAS continues to monitor the move and subsequent services and supports for six months after the move, and identifies advocacy assistance services for the individual from community resources.

W&IC section 4433(b)(1) requires the Department to contract for clients’ rights advocacy services for all individuals with developmental disabilities living in DCs as well as for all consumers residing in the community. The Department has accomplished this by contracting with the DRC Office of Clients’ Rights Advocacy (OCRA) for clients’ rights advocacy for all individuals outside DCs served by RCs. The Department has an interagency agreement with the SCDD to provide advocacy services for residents of the DCs. When a person moves out of SDC, the OCRA Clients’ Rights Advocate (CRA) assumes the responsibility for the clients’ rights advocacy services of the individual

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within the RC catchment area of their residence. The SCDD CRA remains in place at the DC until there are no residents remaining at the DC.

Additionally, W&IC section 4418.25 facilitates coordination between the DC and community CRAs by requiring RCs to provide copies of each DC resident’s comprehensive assessment or update no less than 30 calendar days prior to each resident’s IPP meeting, including the time, date, and location of the IPP meeting to the OCRA CRA for the RC. The OCRA CRA may participate in the meeting unless the consumer objects on his or her own behalf. This allows the OCRA CRAs to become familiar with DC residents prior to their move from the DC and to work collaboratively with the SCDD CRAs at the DC to provide advocacy services as appropriate to each resident.

The Department will continue monitoring the health, safety and well-being of persons transitioning from SDC to the community. As with previous closures, the expectations and a clear process will be in place for post-placement monitoring and required documentation. State employees, RC staff and providers will share the responsibility in assuring identified outcomes are met while providing and accessing resources to make community living successful.

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V. COMMUNITY RESOURCE DEVELOPMENT

The Department has initiated discussions with all of the affected RCs regarding the role of the CPP in the proposed closure of SDC. Statutorily, the goal of the CPP is to provide supplemental funding to RCs to enhance the capacity of the community service delivery system so that individuals with developmental disabilities are afforded the opportunity to live in the least restrictive living arrangement appropriate to their needs. Developing community capacity through the CPP process provides some of the necessary resources to assist in moving people from DCs. The CPP encompasses the full breadth of resource needs including, but not limited to, development of residential homes, community crisis facilities and teams, clinical support services, transportation, training, and day and employment services.

The CPP process will involve careful planning and collaborative efforts of the Department, SDC, RCs, and the SRP. The services and supports needed by each individual, including, but not limited to, living options, day and employment services, health care services and other supports, will be identified through the ID Team’s development of the IPP and through the comprehensive assessment process.

An initial comprehensive assessment of the service and support needs of each person currently living at SDC has been conducted. Community options provided to each person will reflect living options where his or her individual support needs can best be met, and, if desired, as close as possible to the community where his or her family resides. The characteristics of the people who reside at SDC, and of the communities in which their families live are therefore key in determining the array of needed community-based services and supports.

The Department proposes, with the collaboration of the RCs, to focus community resource development on efforts that reflect stable community residential arrangements. In addition to consideration of existing and successful community living options, such as SLS, Adult Family Homes and Family Teaching Homes, ICFs, and Adult Residential Facilities, a specific focus will include the development of homes adapted to meet the unique and specialized medical, physical, and behavioral needs of SDC residents including:

Adult Residential Facility for Persons with Special Health Care Needs

Since the opening of the first Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN) home in 2007, this residential model has shown remarkable success in meeting the needs of some of the most medically fragile consumers that transitioned from a DC. There are now 38 ARFPSHNs in operation statewide. With the statutory changes in AB 1472 (Chapter 25, Statutes of 2012), this model of residential care is now available for any person currently residing in a DC who has an IPP that

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specifies special health care and intensive support needs that indicate the appropriateness of placement in an ARFPSHN.

The ARFPSHN model of care includes: specific staffing requirements relative to 24/7 licensed nursing (Registered Nurse, Licensed Vocational Nurse, Psychiatric Technician); DDS program certification; and mandatory safety features (fire sprinkler system and an alternative back-up power source); and was necessary to fill a critical gap in the existing State residential licensing categories. To live in an ARFPSHN, the consumer’s health conditions must be predictable and stable at the time of admission, as determined by the Individual Health Care Plan team and stated in writing by a physician. In addition to 24/7 nursing supervision, the law requires:

• Development of an Individual Health Care Plan that lists the intensive health care and service supports for each consumer that is updated at least every six months;

• Examination by the consumer’s primary care physician at least once every 60 days;

• At least monthly face-to-face visits with the consumer by a RC nurse;

• DDS approval of the program plan and on-site visits to the homes at least every six months; and

• California Department of Social Services (DSS) licensure of the homes, which includes criminal background clearance, Administrator orientation, annual facility monitoring visits and complaint resolution.

Some residents at SDC may need licensed nursing care. The ARFPSHN model will provide one option for these SDC residents to move to a home-like, community-based setting. Not everyone who lives in an NF residence at SDC will need an ARFPSHN home. There are specific eligibility criteria that must be met to live in an ARFPSHN home and alternative residential models are available that address ongoing medical needs such as: Specialized Residential Facilities (licensed by DSS) and ICFs (licensed by the California Department of Public Health [CDPH]) to provide 24-hour-per-day services. There are three types of ICFs, which all provide services to Californians with developmental disabilities: ICF/DD-H (Habilitative), ICF/DD-N (Nursing) and ICF/DDCN (Continuous Nursing). More information on ICF program types is available online at: http://www.dds.ca.gov/LivingArrang/ICF.cfm.

Enhanced Behavioral Supports Homes

An EBSH is a Community Care Facility (CCF) certified by DDS and licensed by DSS as an adult residential facility or a group home that provides 24-hour nonmedical care to

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http://www.dds.ca.gov/LivingArrang/ICF.cfm

individuals with developmental disabilities who require enhanced behavior supports, staff, and supervision in a homelike setting. EBSHs have a maximum capacity of four consumers. Enhanced behavior services and supports means additional staff supervision, facility enhancements or other services and supports beyond what is typically available in other licensed CCFs, to serve individuals with challenging behaviors in a home-like setting. EBSHs provide intensive behavioral services and supports to adults and children with developmental disabilities who need intensive services and supports due to challenging behaviors that cannot be managed in a community setting without the availability of enhanced behavioral services and supports, and who are at risk of institutionalization or out-of-state placement, or are transitioning to the community from a DC, other state-operated residential facility, institution for mental disease, or out-of-state placement. EBSHs are staffed 24/7 with professional staff and undergo a certification process by the Department, similar to the ARFPSHN certification process.

Currently, 18 EBSHs are scheduled to be developed through 2015-16 and additional EBSHs will be developed each fiscal year during the pilot project period. There are not currently any EBSHs that are operational, as EBSH emergency regulations are still pending. The Department has been working with DSS on regulations for EBSHs and expects them to be released in Fall 2015. The Department is encouraged by the possibilities this model offers to address unmet needs in the community and assist with enhancing behavioral services statewide.

Community Crisis Homes

A CCH is a facility certified by DDS and licensed by DSS as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities in need of crisis intervention services who would otherwise be at risk of admission to the acute crisis unit at Fairview DC (Fairview) or SDC, out-of-state placement, a general acute care hospital, an acute psychiatric hospital or an institution for mental disease. CCHs will meet all statutory requirements for use of behavior interventions including seclusion and restraint. A CCH is authorized to have a have maximum capacity of eight consumers. However, in response to feedback gathered through the 2014 DC Task Force Implementation Workgroups, the Department is looking at developing four, four-bed CCHs instead of the originally proposed two, eight-bed homes given stakeholder concerns that eight people in a crisis home were too many.

CCHs differ from the acute crisis units at Fairview and SDC in that they are located in communities throughout the State and do not require a commitment under W&IC section 6500. CCHs require enhanced staffing and supervision and enhanced staff qualifications. A significant benefit of CCHs is that the homes can accommodate immediate admission for individuals in acute crisis, whereas admission to the acute crisis units at Fairview and SDC can be a more prolonged judicial process.

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Currently, three CCHs are projected for development, including two in North Bay RC’s area. CCH regulations are pending and are expected to be released after the EBSH regulations.

Delayed Egress and Delayed Egress/Secured Perimeter Homes

Health and Safety Code sections 1267.75 and 1531.15 authorize residential facilities utilizing delayed egress devices to also utilize secured perimeters. Delayed Egress/Secured Perimeter homes were developed as residential options affording a degree of security not previously available in the community. These homes are designed for individuals who are difficult to serve in the community who, due to difficultto-manage behaviors or a lack of hazard awareness and impulse control, would pose a risk of harm to themselves or others. At this time, Delayed Egress/Secured Perimeter homes do not qualify for federal funding.

Though often referenced together, it is important to note that a Delayed Egress home does not necessarily have a secured perimeter. Delayed Egress and Delayed Egress/Secured Perimeter models offer two different levels of security to meet significant needs in the community. Delayed egress provides the first level of security, while the addition of a secured perimeter provides an increased level of security to protect the safety of the residents and others. “Delayed egress” means the use of a device or devices in a residential facility that precludes use of exits by the consumer for a predetermined period of time, not to exceed 30 seconds. “Secured perimeter” refers to secured perimeter fences around a facility utilizing delayed egress devices that meets prescribed requirements, such as the requirement that the need for the service be part of an individual’s IPP, that the home meet fire and building codes, that the home provide proper training to staff regarding use and operation, and that the secured perimeter not substitute for adequate staff. A residential facility or group home utilizing delayed egress devices and having six or fewer residents may install and utilize secured perimeters. A limited number of Delayed Egress/Secured Perimeter homes, serving individuals designated as incompetent to stand trial pursuant to Penal Code section 1370.1 and who are receiving competency training, may have as many as 15 residents.

In establishing program standards for Delayed Egress and Secured Perimeter homes, requirements and timelines were established for the completion and updating of a comprehensive assessment of each consumer’s needs, including the identification through the IPP process of the services and supports needed to transition the consumer to a less restrictive living arrangement, and a timeline for identifying or developing those services and supports. The Health and Safety Code establishes a statewide limit on the total number of beds in homes utilizing both delayed egress devices and secured perimeters.

Currently, 25 Delayed Egress homes are in development and six have been completed. Fourteen Delayed Egress/Secured Perimeter homes are in progress and four have

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been completed and are expected